CORRInsights®: Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees

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Periprosthetic joint infection (PJI) is perhaps the most-challenging complication following TKA because the presentation can be varied, the diagnosis is often difficult to make, and the treatments and treatment outcomes are often diverse. Though the rate of PJI is less than 2%, with the continued growth in the numbers of TKAs being performed, nearly 70,000 Americans may experience a PJI every year by 2030 [6]. The sheer size of this number underscores the need for data about the reasons TKAs undergo revision, given the severe associated morbidity and costs.
Recent large clinical and national joint registry studies show infection to be the main early cause of revision with other reasons overtaking PJI after 5 years [1, 13]. The current study by Koh and colleagues, for example, shows that infection is the main cause of revision during the first 15 years after primary TKA.
These studies differ from earlier outcome studies that reported polyethylene wear as the predominant reason for failure [12]. The incidence of wear particle-induced osteolysis and subsequent aseptic loosening has reduced considerably during the past 15 years thanks to the introduction of improved polyethylenes with good oxidative stability [11]. Therefore, a shift in the reasons for reoperations after TKA has occurred from implant-related mechanisms like wear to surgeon- and patient-related mechanisms such as infection, instability, malalignment, and arthrofibrosis. Appropriately, new surgical techniques and antibacterial surface treatments of implants are being proposed as strategies to reduce the risk of early infection.
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